CMS to loosen referral requirements for therapeutic shoes

Friday, November 13, 2020

WASHINGTON – CMS will launch a demonstration project to allow nurse practitioners to certify that therapeutic shoes are necessary. 

Effective Jan. 1, 2021 -Dec. 31, 2025, beneficiaries with diabetes are eligible for the standard Medicare diabetic shoe and shoe inserts benefit if a nurse practitioner refers or certifies the beneficiary. Normally, these items are covered only if a physician refers or certifies. 

The benefit, including volume limits on supplies and billing requirements, is not changing in any way. 

CMS will launch the model in 26 regions: Alaska (statewide), Arkansas (statewide), California (statewide), Colorado (statewide), Delaware (statewide), Florida (statewide), Greater Buffalo region (New York), Greater Kansas City region (Kansas and Missouri), Greater Philadelphia region (Pennsylvania), Hawaii (statewide), Louisiana (statewide), Maine (statewide), Massachusetts (statewide), Michigan (statewide), Montana (statewide), Nebraska (statewide), New Hampshire (statewide), New Jersey (statewide), North Dakota (statewide), North Hudson-Capital region (New York), Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma (statewide), Oregon (statewide), Rhode Island (statewide), Tennessee (statewide), and Virginia (statewide). 

Suppliers servicing beneficiaries in the 26 model demonstration regions should be alert to this information to ensure that documentation from nurse practitioners serving as certifying physicians for therapeutic shoes and inserts are participating in the demonstration project. Only nurse practitioners participating in the demonstration or are billing “incident to” a physician’s services are eligible to serve as the certifying physician for therapeutic shoes and shoe inserts.